8.       Pelvic examination:  

 See also MCQ 11, question 45.

Pelvic examination is a frightful ordeal for most women.

It should not be done unless there is a good prospect that it will yield useful information.

I ban it in my antenatal booking clinic, where it almost never gives any useful data and is a ghastly experience for the patient, who may be having her first adult contact with medical services.

A scan almost always gives better information, e.g. about the gestation or presence of ovarian cysts.

I often do not do pelvic examination in the gynaecological clinic.

Stop and think! In the post natal clinic it is probably the least important examination and is rarely of any value.

If she has stopped bleeding, does not need a smear and the uterus is not palpable abdominally, pelvic examination is a total waste of time.

One of these days a patient is going to sue a doctor for the trauma of an unnecessary pelvic examination. Don’t let it be you!

The postnatal visit should be aimed at ensuring that she is coping well, not suffering from post-natal depression and the baby is thriving.

Contraception needs to be sorted out.

You need to deal with any problems left over from the pregnancy: hypertension, anaemia etc.

Were the pruritus and abnormal liver function tests really due to obstetric cholestasis? (See MCQ1, question 41.)

What are the risks of future pregnancy if things have not been completely normal - e.g. the baby had a congenital defect or she had Caesarean section.

You may suspect endometriosis if you find classical features such as thickening, nodularity and tenderness of the utero-sacral ligaments.

But you can only make the diagnosis by having a look.                                                                                                              R1106.